Dear Friends,<\/p>\n\n\n\n
A federal district court in Alaska recently ordered state prison officials to refer an inmate for sex-change surgery consultation. The judge acknowledged that Alaska\u2019s doctors had sound medical reasons for not recommending the consultation, but he felt legally bound by a flawed court precedent to overrule them anyway.<\/p>\n\n\n\n
Idaho joined Indiana in leading a multi-state coalition asking the Ninth Circuit to reverse that order. Because Idaho sits in the Ninth Circuit, its decisions have a much more direct impact on our laws and federal court cases.<\/p>\n\n\n\n
In Alaska, state medical professionals evaluated this inmate and concluded the surgery wasn\u2019t medically necessary. They determined that other treatments such as mental health care and hormone therapy, which Alaska provides, were more appropriate given the circumstances. The district court agreed Alaska\u2019s medical reasoning was sound. But the judge felt the precedent required him to order the referral anyway, overriding Alaska\u2019s medical team.<\/p>\n\n\n\n
These aren\u2019t proven medical interventions. They\u2019re experimental procedures with serious risks and uncertain benefits, and doctors legitimately disagree about whether they\u2019re appropriate treatment. The medical community remains deeply divided over whether these surgeries are safe, effective, or even appropriate. Major international health authorities have reviewed the evidence and sharply restricted these procedures. The U.K.\u2019s National Health Service and Sweden\u2019s National Board of Health and Welfare both found the proof insufficient. Recent internal documents revealed that advocacy organizations manipulated their standards to support predetermined outcomes rather than following the evidence.<\/p>\n\n\n\n
On top of all of that, Alaska doesn\u2019t even have a single licensed surgeon who performs these procedures. Twenty-three other states are in the same position. The surgery is unavailable to anyone in nearly half the country. States would be forced to pay for out-of-state transfers and surgeries using taxpayer dollars for procedures that aren\u2019t even available locally and are not paid for by taxpayers to the general public.<\/p>\n\n\n\n
The Eighth Amendment prohibits prison officials from being deliberately indifferent to serious medical needs, but it doesn\u2019t require providing every experimental procedure a prisoner demands. Prison officials meet their constitutional duty when they ensure adequate medical care based on professional judgment, even when prisoners disagree with the treatment. Deliberate indifference means ignoring serious medical needs with reckless disregard, not providing every controversial surgery a prisoner wants. But the Ninth Circuit\u2019s decision in Edmo v. Corizon<\/em> erased that distinction, and courts have been bound by it ever since.<\/p>\n\n\n\n Edmo<\/em> was decided in 2019 under Idaho\u2019s previous Attorney General. In that case, the previous Attorney General\u2019s office stipulated\u2014without requiring any proof\u2014that standards from the World Professional Association of Transgender Health (WPATH) were the appropriate benchmark for medical necessity. Both sides agreed to treat WPATH\u2019s guidelines as settled fact. That strategic mistake meant the court never examined whether those standards were medically sound, widely accepted, or based on reliable evidence. The court simply applied what the parties had already agreed was true.<\/p>\n\n\n\n That mistake not only cost the State $2.397 million in attorney\u2019s fees, but it also produced a bad precedent that\u2019s now binding courts across the West like in this case in Alaska.<\/p>\n\n\n\n We\u2019re asking the Ninth Circuit to reverse the district court\u2019s order and limit Edmo<\/em> to its unique facts. In Edmo<\/em>, both parties agreed WPATH standards were appropriate, so the court never examined whether they were reliable. That stipulated record shouldn\u2019t control cases where the medical evidence is actually contested. We\u2019re asking the court to recognize that when medical professionals disagree about whether a treatment is appropriate, and major health authorities have restricted it based on insufficient evidence, the Eighth Amendment doesn\u2019t require states to provide it.<\/p>\n\n\n\n Idaho supports Alaska\u2019s authority to follow its own medical professionals\u2019 judgment. When doctors disagree about whether a treatment is appropriate, the Constitution doesn\u2019t require states to override their medical experts based on a precedent built on stipulated facts.<\/p>\n\n\n\n